Gout is caused by the accumulation of uric acid in the blood, which precipitates into needle-shaped crystals around the joints, causing acute inflammation, pain, swelling, redness, and heat. High levels of uric acid in the blood indicate risk factors for gout, high blood pressure, vascular degeneration, kidney stones, and kidney failure. Therefore, knowing the uric acid level in the blood is important for predicting many diseases.
“Big Toe Joint” – A Common Site… Inflammation from High Uric Acid
When uric acid levels exceed 6.8 mg/dL, there is a chance of joint inflammation. The most common site is the “big toe joint.” In chronic gout patients, inflammation may occur in multiple joints simultaneously. Some may have uric acid deposits accumulating around these joints, forming lumps that can suddenly rupture and become chronic wounds.
These symptoms often occur after socializing with friends, eating meat, and drinking alcohol. At night, swelling, redness, and pain in the big toe can be noticed. When visiting a doctor, blood tests confirm gout, and symptoms improve after taking medication.
Uncertain Locations… Leading to Misdiagnosis
Sometimes, ‘joint pain’ may occur in less common locations or multiple joints, causing diagnostic errors. For example, a doctor once saw a patient who reported hip pain after drinking beer and eating steak. The patient received painkillers, which only temporarily relieved symptoms. The pain and swelling spread to the knees. Knee fluid analysis showed no uric acid crystals, so the doctor said it was not gout and continued prescribing painkillers. The pain then spread to both sides. The dangerous part was that the patient continued taking painkillers for a long time, causing kidney problems. Later, after gout treatment and taking medication to lower uric acid levels, symptoms gradually improved, and kidney function returned to normal.
Eating Duck or Chicken – Is It the Cause of Gout?
Most people believe gout is caused by eating duck or chicken, or even vegetable shoots. In reality, the food we eat is only one factor that may trigger the disease but not the whole story. Duck or chicken can raise uric acid levels by no more than 1 mg/dL. This explains why even after stopping eating duck or chicken, gout symptoms do not completely disappear.
However, this does not mean gout patients can eat duck or chicken freely. If you are prone to gout and already have high uric acid levels, eating duck or chicken may trigger symptoms. As for vegetable shoots, they do not raise uric acid levels significantly and are not a major cause of gout.
Alcohol Consumption… and Gout
Alcohol is a major cause of high uric acid levels and gout. After drinking, there is a chance of severe pain and swelling in the big toe. Alcohol also makes the blood acidic, causing uric acid to precipitate in the joints and triggering severe inflammation. Different types of alcohol affect uric acid levels differently: beer raises uric acid levels more than whiskey, while wine raises uric acid levels only slightly. Therefore, for gout patients, it is better to stop drinking alcohol. If drinking socially, it is recommended to choose wine and avoid beer as much as possible.
Consuming Excess Sugar or Sweets Increases Gout Risk
Few people know that consuming more than 50 grams of fruit sugar, called fructose, per day can cause high uric acid levels and lead to gout. A concerning source of fructose is boxed fruit juices and soft drinks. Research shows that regularly drinking more than one glass of soft drinks or boxed fruit juice per day can raise uric acid levels enough to cause gout.
How Does Consuming Fruit Sugar or Fructose Raise Uric Acid Levels?
The answer is… when large amounts of fructose are metabolized in the body, they produce a substance called AMP (adenosine monophosphate). AMP is then converted by the body into uric acid in the blood. Therefore, not only eating meat but also drinking soft drinks or boxed fruit juices with high fructose content can raise uric acid levels more than eating duck or chicken.
How to Treat When “Gout” Strikes
Initial gout treatment involves anti-inflammatory and pain-relieving medications. Once pain subsides, medications to reduce uric acid production are prescribed to keep uric acid levels within normal range. The problem is that patients often think they only need painkillers when in pain and stop medication when symptoms disappear, ignoring uric acid level monitoring. They do not realize that prolonged high uric acid levels damage blood vessels and kidneys. By the time they realize, they may have developed high blood pressure or kidney failure. Therefore, gout patients should consult doctors to continuously use uric acid-lowering medications.
Doctors often recommend gout patients carry colchicine. If acute joint pain occurs, take one tablet immediately. If symptoms do not improve within two hours, take another tablet. Side effects of colchicine include diarrhea. If symptoms persist after two tablets, see a doctor to consider stronger anti-inflammatory medication.
Continuous use of colchicine to prevent gout symptoms is not recommended because it leads to unnecessary medication. Proper gout treatment involves controlling uric acid levels by reducing meat consumption, avoiding alcohol, and limiting soft drink intake.
One safe medication to prevent gout symptoms is sodium bicarbonate, or Sodamint. Take 2-3 tablets 2-3 times a day. Sodamint helps prevent blood acidity, which causes uric acid precipitation. Doctors consider Sodamint the cheapest anti-aging drug, costing less than one baht per tablet. Sodamint not only prevents gout but also reduces acidity and protects kidney function.
For those with very high uric acid levels, consultation with a doctor about using allopurinol is necessary. Allopurinol may cause severe allergic reactions such as Stevens-Johnson syndrome, but this is rare and should be managed under medical supervision. Allopurinol not only treats gout but also slows kidney deterioration and enhances blood pressure medication effects. Remember, leaving uric acid levels high without medication due to fear of allergy (which may not occur) can lead to vascular degeneration and chronic kidney failure, which are more dangerous and severe.
Uric Acid – A Risk Factor for Metabolic Diseases
Everyone knows gout is joint inflammation caused by high uric acid levels. What is less known is that “high uric acid” is not only a risk factor for gout but also for serious diseases such as high blood pressure, kidney stones, diabetes, and chronic kidney failure. Since uric acid blood tests are not usually included in general health checkups, it is recommended to have detailed testing, especially for men. Men have higher uric acid levels than women because female hormones increase uric acid excretion through the kidneys. Therefore, gout is more common in men, but postmenopausal women with decreased hormones can also develop gout.
For those who have had blood tests showing high uric acid levels, doctors usually just say “Your uric acid is high; don’t eat too much duck or chicken, or you might get gout.” Do not take this lightly. Start controlling your diet, reduce starch, exercise, lose weight, avoid alcohol (or choose wine instead of beer), and remember that soft drinks and boxed fruit juices also raise uric acid levels.
High Uric Acid and Gout Are Not Minor Issues
I emphasize that high uric acid and gout are not minor issues. Do not ignore them thinking they are just joint diseases. Waiting until symptoms appear and taking medication occasionally may end in kidney failure or vascular degeneration. Many elderly patients visit doctors with unexplained gastrointestinal bleeding. Endoscopy shows no clear bleeding points, but this is due to uric acid precipitating in acidic conditions, forming needle-shaped crystals that pierce degenerated blood vessels. If doctors do not check uric acid levels or treat (with intravenous sodium bicarbonate), patients may bleed to death. Some patients have had almost their entire intestines removed and survive only on lifelong intravenous nutrition.
Everyone needs to know their uric acid levels for prevention and treatment because if left untreated, chronic and serious diseases including kidney failure will definitely follow.
